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MANDATORY SERVICES
Services for categorically needy eligibility groups:
Medicaid eligibility groups classified as categorically needy are entitled to the following services unless waived under section 1115 of the Medicaid law. These service entitlements do not apply to the SCHIP programs.
- Inpatient hospital (excluding inpatient services in institutions formental disease).
- Outpatient hospital including Federally Qualified Health Centers (FQHCs) and if permitted under state law, rural health clinic and other ambulatory services provided by a rural health clinic which are otherwise included under states’ plans.
- Other laboratory and x-ray.
- Certified pediatric and family nurse practitioners (when licensed to practice under state law).
- Nursing facility services for beneficiaries age 21 and older.
- Early and periodic screening, diagnosis, and treatment (EPSDT) for children under age 21.*
- Family planning services and supplies.
- Physicians’ services.
- Medical and surgical services of a dentist.
- Home health services for beneficiaries who are entitled to nursing facility services under the state’s Medicaid plan.
- Intermittent or part-time nursing services provided by home
health agency or by a registered nurse when there is no home
health agency in the area. - Home health aides.
- Medical supplies and appliances for use in the home.
- Nurse mid-wife services.
- Pregnancy related services and service for other conditions that might complicate pregnancy.
- 60 days postpartum pregnancy related services.
*Under the EPSDT program, states are required to provide all medically necessary services. This includes services that would otherwise be optional services.